Form Cac 2 - Statement Of Share Capital And Return Of Allotment Page 2
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1
2NAME AND ADDRESS OF SHAREHOLDERS
No. of
Type of
Shares
Shares
Allotted
Name:
Address:
City
State
P.O. Box
Email
Name:
Address:
City
State
P.O Box
Email
Name:
Address:
City
State
P.O Box
Email
Name:
Address:
City
State
P.O Box
Email
_________________________
_______________________
Signature of Director
Name of Director
& Tel. No.
Presented for filing by:
Name: __________________________________________________ Accreditation Number: ________________________________
Address: ____________________________________________________________________________________________________
Tel. No. & E-mail: ________________________________________________ Signature & Date: ____________________________
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